Fiona Rahbar, MD

Effective staffing is central to delivering high-quality, efficient dermatologic care. In the current landscape of American medicine, dermatologists manage complex medical conditions, perform surgical procedures, and in some cases expand into elective aesthetic services. The ability to offer advanced clinical services is dependent on the performance of those who operate equipment and sustain daily operations.

The “perfect” hire is therefore not a luxury but a necessity for practice survival: with shrinking reimbursements and rising administrative burden, staff capability influences clinic efficiency, medicolegal risk, and patient experience and outcomes. A dysfunctional team can contribute to physician burnout, whereas a high‑functioning one enables dermatologists to practice at the top of their license by focusing on diagnosis and complex interventions while the office functions efficiently. In this article, we examine the anatomy of modern dermatology hiring and highlight the benefits of shifting from reactive staffing to proactive talent acquisition.

PHASE 1: THE PHILOSOPHY OF THE DERMATOLOGY-SPECIFIC PROFILE

Before drafting a job description, it is important to have an idea of what the ideal candidate embodies. A medical assistant in a high-volume Mohs surgery suite requires a vastly different temperament and skill set than an aesthetic coordinator in a boutique cosmetic practice. Here are some factors to consider when approaching your ideal hire.

The Hybridity of the Specialty

Dermatology is unique in that the same patient can be treated for a life-threatening melanoma and a bothersome wrinkle within the same afternoon. This requires staff who can pivot emotionally and technically. When looking for a new employee, prioritize the 4 pillars of the ideal dermatology assistant: clinical competency, a hospitality mindset, digital agility, and a “get it done” mindset.

Clinical Competency—A basic understanding of skin anatomy and common pathologies is vital, even for nonclinical roles. A front-desk employee who understands the urgency of a changing mole in a patient with melanoma vs a new acne cyst is a vital triage asset.

Hospitality Mindset—When operating a dermatology clinic with offerings in the elective space (ie, aesthetics), be aware that patients increasingly are viewing themselves as consumers in these spaces. Dermatologists should look for candidates who have experience in high-end service industries such as retail, hospitality, or concierge services. These individuals understand that the patient experience begins in the parking lot and ends with the follow-up call.

Digital Agility—We are in the midst of a technological revolution. Between AI-driven diagnostic assistance, teledermatology platforms, and integrated electronic medical record/billing systems, the modern employee has to be more than just computer literate—they must be digitally native (eg, able to troubleshoot a tablet-based consent form or explain a patient portal with ease).

“Get It Done” Mindset—In a fast-paced dermatology clinic, it is important to find someone who looks for work instead of waiting for orders; otherwise, you might find yourself spending more time directing your employees than getting your actual work done.

The Culture Fit vs Culture Add

Traditionally, practices have prioritized hiring for “culture fit”—that is, looking for individuals who think and behave like existing staff. Contemporary management theory, however, favors hiring for “culture add,” recruiting candidates who contribute perspectives and skills absent from the current team. For practices expanding into aesthetics or focusing on a specific aspect of dermatology, the practice needs employees who bring perspectives it lacks. Perhaps the candidate has a background in hospitality, or they are involved in community health initiatives. These “adds” broaden the practice’s reach and depth.

PHASE 2: THE STRATEGIC RECRUITMENT PROCESS

The days of putting up “Help Wanted” signs are over. To find elite talent, dermatologists must treat recruitment like a diagnostic workup: thorough, methodical, and evidence based. Follow these steps for a thoughtful progression in finding the right candidate for your practice.

Step 1: Crafting a Magnetic Job Description

Most job postings read like a dry list of tasks: Take vitals, room patients, call in prescriptions. These descriptions attract clock-punchers. To attract careerists, the vision must be sold. An effective job description should include 2 main components: the vision statement and the growth path.

The Vision Statement—Start by stating your practice’s mission. If you’re focused on building a practice that values concierge-style care with long visit times, say so: “Join a team dedicated to patient care, slowing down, and personalized services.”

The Growth Path—High-quality candidates want to focus on their career trajectory. During the interview, mention opportunities for laser certification, scribe training, or management tracks. For those on a path toward higher education, describe the breadth of clinical training and experience.

Step 2: The Tiered Interview Protocol

We recommend a 3-tiered approach to the interview process to ensure multiple data points are collected before an offer is made: a behavior screen, a “shadow day,” and a “no doctor” zone.

Tier 1: The Behavioral Screen (Remote)—Conduct a 20-minute video call focused purely on soft skills using questions from the STAR method (Situation, Task, Action, Result). For example, ask something like, “Tell me about a time you may have faced an unsatisfied client. How did you de-escalate the situation?” Pay attention to whether the candidate takes responsibility or places blame.

Tier 2: The Shadow Day (Working Interview)—This can be an important part of the hiring process. We recommend inviting top candidates for a paid half- or full-day trial to assess how they perform in a real-world clinical setting. For medical assistant candidates, evaluate their ability to remain task focused and efficient and observe how they handle situations such as the sight of blood or interactions with needle-phobic patients. For front-desk candidates, pay attention to how they prioritize competing responsibilities and their openness to learning and feedback. For all positions, observing interactions with both patients and team members can provide valuable insight into professionalism, communication skills, and overall fit within the practice.

Tier 3: The “No-Doctor” Zone (Optional)—Leave the candidate alone with the current staff, if only for a few minutes. This allows the employer to gauge not only the candidate’s behavior with a senior member of staff but also with other members of the team, allowing for demonstration of character. Ask the team to assess if this is someone they would want to spend a workday with. If the staff says no, that may affect your choice of hire as well.  

PHASE 3: THE OFFER AND THE LEGAL GUARDRAILS

After finding the unicorn candidate, the closing process must be professional and legally sound. Here are the steps we have found most helpful to take once a decision for a hire is made.

The Offer Letter as a Blueprint

An offer letter is more than a salary statement; it is a document of expectations. It should include the following components:

• Clear Compensation Structure: Base pay plus any performance-based incentives (eg, bonuses for retail skin care sales or conversion rates on cosmetic consultations).
• Specific Benefit Clauses: Paid time off, benefits such as health insurance and 401(k) matching if you are offering, and professional perks such as discounted treatments or skin care stipends.
• At-Will Statement: Ensure your legal counsel has reviewed your at-will employment clauses to protect the practice. This allows the employer to terminate an employee without legal liability and conversely gives the employee flexibility to leave the position if it does not fit their needs.
• Employee Manual: Once formally hired, make sure you have an employee handbook with your expectations and regulations—ranging from dress code and safety regulations to paid time off—clearly written. Be more specific than you think is necessary, which will prevent potential discrepancies down the road.  

Onboarding: The First 90 Days

The first 90 days of employment are the most volatile. Statistics show that the majority of staff turnover happens in this window.¹ To mitigate this, use the following 90-day success map:

• The Immersion Period (Days 1-30): The new hire should not be expected to produce. They are there to learn the culture of the clinic: the protocols for rooming, the vernacular for explaining procedures, and the standards for documentation.
• The Guided Execution Period (Days 31-60): They begin performing tasks under the direct supervision of a senior lead.
• The Independent Integration Period (Days 61-90): They take on a full load, with weekly check-ins to address friction points.

PHASE 4: RETENTION THROUGH ­PROFESSIONAL DEVELOPMENT

In dermatology practices, staff members frequently are approached by competitors, medical spas, and industry representatives to work for them. Retention is not just about the paycheck; it’s about the “professional home.” Staff members want to feel valued and have a responsible role in the workplace.

As dermatologists, we often are seen as the captain of the ship; however, the most successful practices operate as high-reliability organizations. In this type of practice, everyone from the janitorial staff to the senior associate is encouraged to speak up if there is a safety issue or an efficiency gap. Here are some techniques to foster this culture.

The Weekly Huddle—For practices that are just starting to expand, this is a great way to make sure that friction points and difficulties are addressed before becoming a larger issue. Gathering the staff for just 15 minutes in the morning before clinic begins can be a great way to address housekeeping issues, encourage staff to speak up about problems they may have identified, and provide a chance for everyone to feel heard.

The Educational Bend—Encourage staff to grow their wealth of knowledge, whether from industry-sponsored educational product events to formal certifications. A front desk assistant who then moves on to get their advanced degree may return to the practice as a nurse and become a valuable partner and asset. 

PHASE 5: LOOKING TOWARD THE FUTURE

As we look toward 2027 and beyond, the employee of the future may not be entirely human. We already are seeing the integration of AI scribes and automated billing auditors. Practices should look for candidates who aren’t afraid of AI but are excited by it. A medical assistant who can oversee an AI scribe while still maintaining eye contact and holding a patient’s hand during a painful injection is the gold standard.

Final Thoughts

Our medical school training prepares us for the “what” of dermatology, but it rarely prepares us for the “who.” As practice managers, we are thrust into the role of CEO, human resources director, and culture architect without a formal syllabus. By applying the same clinical rigor to the hiring process that we do to a complex diagnostic case, we can build teams that don’t just work for us but build with us. The goal is a practice where the physician can focus on the art and science of the skin, confident that every other aspect of the patient journey is being handled by a team that is as dedicated, ethical, and clinical as they are. Hiring is one of the most difficult procedures you will likely perform in your practice; it also is the one with the highest long-term success rate if performed with thoughtfulness, precision, and above all, kindness.

Effective staffing is central to delivering high-quality, efficient dermatologic care. In the current landscape of American medicine, dermatologists manage complex medical conditions, perform surgical procedures, and in some cases expand into elective aesthetic services. The ability to offer advanced clinical services is dependent on the performance of those who operate equipment and sustain daily operations.

The “perfect” hire is therefore not a luxury but a necessity for practice survival: with shrinking reimbursements and rising administrative burden, staff capability influences clinic efficiency, medicolegal risk, and patient experience and outcomes. A dysfunctional team can contribute to physician burnout, whereas a high‑functioning one enables dermatologists to practice at the top of their license by focusing on diagnosis and complex interventions while the office functions efficiently. In this article, we examine the anatomy of modern dermatology hiring and highlight the benefits of shifting from reactive staffing to proactive talent acquisition.

PHASE 1: THE PHILOSOPHY OF THE DERMATOLOGY-SPECIFIC PROFILE

Before drafting a job description, it is important to have an idea of what the ideal candidate embodies. A medical assistant in a high-volume Mohs surgery suite requires a vastly different temperament and skill set than an aesthetic coordinator in a boutique cosmetic practice. Here are some factors to consider when approaching your ideal hire.

The Hybridity of the Specialty

Dermatology is unique in that the same patient can be treated for a life-threatening melanoma and a bothersome wrinkle within the same afternoon. This requires staff who can pivot emotionally and technically. When looking for a new employee, prioritize the 4 pillars of the ideal dermatology assistant: clinical competency, a hospitality mindset, digital agility, and a “get it done” mindset.

Clinical Competency—A basic understanding of skin anatomy and common pathologies is vital, even for nonclinical roles. A front-desk employee who understands the urgency of a changing mole in a patient with melanoma vs a new acne cyst is a vital triage asset.

Hospitality Mindset—When operating a dermatology clinic with offerings in the elective space (ie, aesthetics), be aware that patients increasingly are viewing themselves as consumers in these spaces. Dermatologists should look for candidates who have experience in high-end service industries such as retail, hospitality, or concierge services. These individuals understand that the patient experience begins in the parking lot and ends with the follow-up call.

Digital Agility—We are in the midst of a technological revolution. Between AI-driven diagnostic assistance, teledermatology platforms, and integrated electronic medical record/billing systems, the modern employee has to be more than just computer literate—they must be digitally native (eg, able to troubleshoot a tablet-based consent form or explain a patient portal with ease).

“Get It Done” Mindset—In a fast-paced dermatology clinic, it is important to find someone who looks for work instead of waiting for orders; otherwise, you might find yourself spending more time directing your employees than getting your actual work done.

The Culture Fit vs Culture Add

Traditionally, practices have prioritized hiring for “culture fit”—that is, looking for individuals who think and behave like existing staff. Contemporary management theory, however, favors hiring for “culture add,” recruiting candidates who contribute perspectives and skills absent from the current team. For practices expanding into aesthetics or focusing on a specific aspect of dermatology, the practice needs employees who bring perspectives it lacks. Perhaps the candidate has a background in hospitality, or they are involved in community health initiatives. These “adds” broaden the practice’s reach and depth.

PHASE 2: THE STRATEGIC RECRUITMENT PROCESS

The days of putting up “Help Wanted” signs are over. To find elite talent, dermatologists must treat recruitment like a diagnostic workup: thorough, methodical, and evidence based. Follow these steps for a thoughtful progression in finding the right candidate for your practice.

Step 1: Crafting a Magnetic Job Description

Most job postings read like a dry list of tasks: Take vitals, room patients, call in prescriptions. These descriptions attract clock-punchers. To attract careerists, the vision must be sold. An effective job description should include 2 main components: the vision statement and the growth path.

The Vision Statement—Start by stating your practice’s mission. If you’re focused on building a practice that values concierge-style care with long visit times, say so: “Join a team dedicated to patient care, slowing down, and personalized services.”

The Growth Path—High-quality candidates want to focus on their career trajectory. During the interview, mention opportunities for laser certification, scribe training, or management tracks. For those on a path toward higher education, describe the breadth of clinical training and experience.

Step 2: The Tiered Interview Protocol

We recommend a 3-tiered approach to the interview process to ensure multiple data points are collected before an offer is made: a behavior screen, a “shadow day,” and a “no doctor” zone.

Tier 1: The Behavioral Screen (Remote)—Conduct a 20-minute video call focused purely on soft skills using questions from the STAR method (Situation, Task, Action, Result). For example, ask something like, “Tell me about a time you may have faced an unsatisfied client. How did you de-escalate the situation?” Pay attention to whether the candidate takes responsibility or places blame.

Tier 2: The Shadow Day (Working Interview)—This can be an important part of the hiring process. We recommend inviting top candidates for a paid half- or full-day trial to assess how they perform in a real-world clinical setting. For medical assistant candidates, evaluate their ability to remain task focused and efficient and observe how they handle situations such as the sight of blood or interactions with needle-phobic patients. For front-desk candidates, pay attention to how they prioritize competing responsibilities and their openness to learning and feedback. For all positions, observing interactions with both patients and team members can provide valuable insight into professionalism, communication skills, and overall fit within the practice.

Tier 3: The “No-Doctor” Zone (Optional)—Leave the candidate alone with the current staff, if only for a few minutes. This allows the employer to gauge not only the candidate’s behavior with a senior member of staff but also with other members of the team, allowing for demonstration of character. Ask the team to assess if this is someone they would want to spend a workday with. If the staff says no, that may affect your choice of hire as well.  

PHASE 3: THE OFFER AND THE LEGAL GUARDRAILS

After finding the unicorn candidate, the closing process must be professional and legally sound. Here are the steps we have found most helpful to take once a decision for a hire is made.

The Offer Letter as a Blueprint

An offer letter is more than a salary statement; it is a document of expectations. It should include the following components:

• Clear Compensation Structure: Base pay plus any performance-based incentives (eg, bonuses for retail skin care sales or conversion rates on cosmetic consultations).
• Specific Benefit Clauses: Paid time off, benefits such as health insurance and 401(k) matching if you are offering, and professional perks such as discounted treatments or skin care stipends.
• At-Will Statement: Ensure your legal counsel has reviewed your at-will employment clauses to protect the practice. This allows the employer to terminate an employee without legal liability and conversely gives the employee flexibility to leave the position if it does not fit their needs.
• Employee Manual: Once formally hired, make sure you have an employee handbook with your expectations and regulations—ranging from dress code and safety regulations to paid time off—clearly written. Be more specific than you think is necessary, which will prevent potential discrepancies down the road.  

Onboarding: The First 90 Days

The first 90 days of employment are the most volatile. Statistics show that the majority of staff turnover happens in this window.¹ To mitigate this, use the following 90-day success map:

• The Immersion Period (Days 1-30): The new hire should not be expected to produce. They are there to learn the culture of the clinic: the protocols for rooming, the vernacular for explaining procedures, and the standards for documentation.
• The Guided Execution Period (Days 31-60): They begin performing tasks under the direct supervision of a senior lead.
• The Independent Integration Period (Days 61-90): They take on a full load, with weekly check-ins to address friction points.

PHASE 4: RETENTION THROUGH ­PROFESSIONAL DEVELOPMENT

In dermatology practices, staff members frequently are approached by competitors, medical spas, and industry representatives to work for them. Retention is not just about the paycheck; it’s about the “professional home.” Staff members want to feel valued and have a responsible role in the workplace.

As dermatologists, we often are seen as the captain of the ship; however, the most successful practices operate as high-reliability organizations. In this type of practice, everyone from the janitorial staff to the senior associate is encouraged to speak up if there is a safety issue or an efficiency gap. Here are some techniques to foster this culture.

The Weekly Huddle—For practices that are just starting to expand, this is a great way to make sure that friction points and difficulties are addressed before becoming a larger issue. Gathering the staff for just 15 minutes in the morning before clinic begins can be a great way to address housekeeping issues, encourage staff to speak up about problems they may have identified, and provide a chance for everyone to feel heard.

The Educational Bend—Encourage staff to grow their wealth of knowledge, whether from industry-sponsored educational product events to formal certifications. A front desk assistant who then moves on to get their advanced degree may return to the practice as a nurse and become a valuable partner and asset. 

PHASE 5: LOOKING TOWARD THE FUTURE

As we look toward 2027 and beyond, the employee of the future may not be entirely human. We already are seeing the integration of AI scribes and automated billing auditors. Practices should look for candidates who aren’t afraid of AI but are excited by it. A medical assistant who can oversee an AI scribe while still maintaining eye contact and holding a patient’s hand during a painful injection is the gold standard.

Final Thoughts

Our medical school training prepares us for the “what” of dermatology, but it rarely prepares us for the “who.” As practice managers, we are thrust into the role of CEO, human resources director, and culture architect without a formal syllabus. By applying the same clinical rigor to the hiring process that we do to a complex diagnostic case, we can build teams that don’t just work for us but build with us. The goal is a practice where the physician can focus on the art and science of the skin, confident that every other aspect of the patient journey is being handled by a team that is as dedicated, ethical, and clinical as they are. Hiring is one of the most difficult procedures you will likely perform in your practice; it also is the one with the highest long-term success rate if performed with thoughtfulness, precision, and above all, kindness.

Effective staffing is central to delivering high-quality, efficient dermatologic care. In the current landscape of American medicine, dermatologists manage complex medical conditions, perform surgical procedures, and in some cases expand into elective aesthetic services. The ability to offer advanced clinical services is dependent on the performance of those who operate equipment and sustain daily operations.

The “perfect” hire is therefore not a luxury but a necessity for practice survival: with shrinking reimbursements and rising administrative burden, staff capability influences clinic efficiency, medicolegal risk, and patient experience and outcomes. A dysfunctional team can contribute to physician burnout, whereas a high‑functioning one enables dermatologists to practice at the top of their license by focusing on diagnosis and complex interventions while the office functions efficiently. In this article, we examine the anatomy of modern dermatology hiring and highlight the benefits of shifting from reactive staffing to proactive talent acquisition.

PHASE 1: THE PHILOSOPHY OF THE DERMATOLOGY-SPECIFIC PROFILE

Before drafting a job description, it is important to have an idea of what the ideal candidate embodies. A medical assistant in a high-volume Mohs surgery suite requires a vastly different temperament and skill set than an aesthetic coordinator in a boutique cosmetic practice. Here are some factors to consider when approaching your ideal hire.

The Hybridity of the Specialty

Dermatology is unique in that the same patient can be treated for a life-threatening melanoma and a bothersome wrinkle within the same afternoon. This requires staff who can pivot emotionally and technically. When looking for a new employee, prioritize the 4 pillars of the ideal dermatology assistant: clinical competency, a hospitality mindset, digital agility, and a “get it done” mindset.

Clinical Competency—A basic understanding of skin anatomy and common pathologies is vital, even for nonclinical roles. A front-desk employee who understands the urgency of a changing mole in a patient with melanoma vs a new acne cyst is a vital triage asset.

Hospitality Mindset—When operating a dermatology clinic with offerings in the elective space (ie, aesthetics), be aware that patients increasingly are viewing themselves as consumers in these spaces. Dermatologists should look for candidates who have experience in high-end service industries such as retail, hospitality, or concierge services. These individuals understand that the patient experience begins in the parking lot and ends with the follow-up call.

Digital Agility—We are in the midst of a technological revolution. Between AI-driven diagnostic assistance, teledermatology platforms, and integrated electronic medical record/billing systems, the modern employee has to be more than just computer literate—they must be digitally native (eg, able to troubleshoot a tablet-based consent form or explain a patient portal with ease).

“Get It Done” Mindset—In a fast-paced dermatology clinic, it is important to find someone who looks for work instead of waiting for orders; otherwise, you might find yourself spending more time directing your employees than getting your actual work done.

The Culture Fit vs Culture Add

Traditionally, practices have prioritized hiring for “culture fit”—that is, looking for individuals who think and behave like existing staff. Contemporary management theory, however, favors hiring for “culture add,” recruiting candidates who contribute perspectives and skills absent from the current team. For practices expanding into aesthetics or focusing on a specific aspect of dermatology, the practice needs employees who bring perspectives it lacks. Perhaps the candidate has a background in hospitality, or they are involved in community health initiatives. These “adds” broaden the practice’s reach and depth.

PHASE 2: THE STRATEGIC RECRUITMENT PROCESS

The days of putting up “Help Wanted” signs are over. To find elite talent, dermatologists must treat recruitment like a diagnostic workup: thorough, methodical, and evidence based. Follow these steps for a thoughtful progression in finding the right candidate for your practice.

Step 1: Crafting a Magnetic Job Description

Most job postings read like a dry list of tasks: Take vitals, room patients, call in prescriptions. These descriptions attract clock-punchers. To attract careerists, the vision must be sold. An effective job description should include 2 main components: the vision statement and the growth path.

The Vision Statement—Start by stating your practice’s mission. If you’re focused on building a practice that values concierge-style care with long visit times, say so: “Join a team dedicated to patient care, slowing down, and personalized services.”

The Growth Path—High-quality candidates want to focus on their career trajectory. During the interview, mention opportunities for laser certification, scribe training, or management tracks. For those on a path toward higher education, describe the breadth of clinical training and experience.

Step 2: The Tiered Interview Protocol

We recommend a 3-tiered approach to the interview process to ensure multiple data points are collected before an offer is made: a behavior screen, a “shadow day,” and a “no doctor” zone.

Tier 1: The Behavioral Screen (Remote)—Conduct a 20-minute video call focused purely on soft skills using questions from the STAR method (Situation, Task, Action, Result). For example, ask something like, “Tell me about a time you may have faced an unsatisfied client. How did you de-escalate the situation?” Pay attention to whether the candidate takes responsibility or places blame.

Tier 2: The Shadow Day (Working Interview)—This can be an important part of the hiring process. We recommend inviting top candidates for a paid half- or full-day trial to assess how they perform in a real-world clinical setting. For medical assistant candidates, evaluate their ability to remain task focused and efficient and observe how they handle situations such as the sight of blood or interactions with needle-phobic patients. For front-desk candidates, pay attention to how they prioritize competing responsibilities and their openness to learning and feedback. For all positions, observing interactions with both patients and team members can provide valuable insight into professionalism, communication skills, and overall fit within the practice.

Tier 3: The “No-Doctor” Zone (Optional)—Leave the candidate alone with the current staff, if only for a few minutes. This allows the employer to gauge not only the candidate’s behavior with a senior member of staff but also with other members of the team, allowing for demonstration of character. Ask the team to assess if this is someone they would want to spend a workday with. If the staff says no, that may affect your choice of hire as well.  

PHASE 3: THE OFFER AND THE LEGAL GUARDRAILS

After finding the unicorn candidate, the closing process must be professional and legally sound. Here are the steps we have found most helpful to take once a decision for a hire is made.

The Offer Letter as a Blueprint

An offer letter is more than a salary statement; it is a document of expectations. It should include the following components:

• Clear Compensation Structure: Base pay plus any performance-based incentives (eg, bonuses for retail skin care sales or conversion rates on cosmetic consultations).
• Specific Benefit Clauses: Paid time off, benefits such as health insurance and 401(k) matching if you are offering, and professional perks such as discounted treatments or skin care stipends.
• At-Will Statement: Ensure your legal counsel has reviewed your at-will employment clauses to protect the practice. This allows the employer to terminate an employee without legal liability and conversely gives the employee flexibility to leave the position if it does not fit their needs.
• Employee Manual: Once formally hired, make sure you have an employee handbook with your expectations and regulations—ranging from dress code and safety regulations to paid time off—clearly written. Be more specific than you think is necessary, which will prevent potential discrepancies down the road.  

Onboarding: The First 90 Days

The first 90 days of employment are the most volatile. Statistics show that the majority of staff turnover happens in this window.¹ To mitigate this, use the following 90-day success map:

• The Immersion Period (Days 1-30): The new hire should not be expected to produce. They are there to learn the culture of the clinic: the protocols for rooming, the vernacular for explaining procedures, and the standards for documentation.
• The Guided Execution Period (Days 31-60): They begin performing tasks under the direct supervision of a senior lead.
• The Independent Integration Period (Days 61-90): They take on a full load, with weekly check-ins to address friction points.

PHASE 4: RETENTION THROUGH ­PROFESSIONAL DEVELOPMENT

In dermatology practices, staff members frequently are approached by competitors, medical spas, and industry representatives to work for them. Retention is not just about the paycheck; it’s about the “professional home.” Staff members want to feel valued and have a responsible role in the workplace.

As dermatologists, we often are seen as the captain of the ship; however, the most successful practices operate as high-reliability organizations. In this type of practice, everyone from the janitorial staff to the senior associate is encouraged to speak up if there is a safety issue or an efficiency gap. Here are some techniques to foster this culture.

The Weekly Huddle—For practices that are just starting to expand, this is a great way to make sure that friction points and difficulties are addressed before becoming a larger issue. Gathering the staff for just 15 minutes in the morning before clinic begins can be a great way to address housekeeping issues, encourage staff to speak up about problems they may have identified, and provide a chance for everyone to feel heard.

The Educational Bend—Encourage staff to grow their wealth of knowledge, whether from industry-sponsored educational product events to formal certifications. A front desk assistant who then moves on to get their advanced degree may return to the practice as a nurse and become a valuable partner and asset. 

PHASE 5: LOOKING TOWARD THE FUTURE

As we look toward 2027 and beyond, the employee of the future may not be entirely human. We already are seeing the integration of AI scribes and automated billing auditors. Practices should look for candidates who aren’t afraid of AI but are excited by it. A medical assistant who can oversee an AI scribe while still maintaining eye contact and holding a patient’s hand during a painful injection is the gold standard.

Final Thoughts

Our medical school training prepares us for the “what” of dermatology, but it rarely prepares us for the “who.” As practice managers, we are thrust into the role of CEO, human resources director, and culture architect without a formal syllabus. By applying the same clinical rigor to the hiring process that we do to a complex diagnostic case, we can build teams that don’t just work for us but build with us. The goal is a practice where the physician can focus on the art and science of the skin, confident that every other aspect of the patient journey is being handled by a team that is as dedicated, ethical, and clinical as they are. Hiring is one of the most difficult procedures you will likely perform in your practice; it also is the one with the highest long-term success rate if performed with thoughtfulness, precision, and above all, kindness.

Choosing an electronic medical record (EMR) is one of the most important clinical and financial decisions a dermatology practice will make. An effective system can help streamline workflows, support high-quality patient care, and protect revenue, while the wrong choice can slow clinicians down and add to the administrative burden.

Dermatology workflows involve unique documentation, imaging, and billing needs that are not always well served by generic EMR platforms. To help guide the selection of an EMR, the following framework outlines key features and practice considerations specific to dermatology practices.

Dermatology-Specific Charting

While many general EMRs offer customization, dermatology practices benefit greatly from ready-built, specialty-specific documentation tools. Key elements to evaluate include the following:

• Preconfigured dermatology templates for common conditions and procedures (eg, acne, psoriasis, melanoma, biopsies, cosmetic treatments)
• Smart-phrase libraries tailored to dermatologic language and examinations
• Ability to create, modify, and share custom templates across providers

Why It Matters—Efficient charting reduces documentation time, improves consistency, and supports accurate coding.

Clinical Photography and Imaging

Dermatology is a highly visual specialty, making clinical photography and image management essential. Important capabilities of an EMR include the following:

• Easy capture, annotation, and longitudinal tracking of clinical images
• Seamless embedding of photographs directly into the patient chart
• Side-by-side comparison of current and prior images
• Secure image storage and camera integration
• Body-mapping tools to mark and track lesion locations visually

Why It Matters—A high-quality image workflow supports diagnosis, treatment planning, patient education, and medicolegal documentation.

Coding, Billing, and Revenue Cycle Support

For insurance-based practices, robust billing and revenue cycle management (RCM) tools are critical. For direct-care models, some of these items may be prioritized lower. Key features to compare include the following:

• Support for International Classification of Diseases, 10th Revision, Clinical Modification; Current Procedural Terminology; and dermatology-specific code sets
• Automated coding suggestions tied to clinical documentation
• Reviewing claims for errors and inconsistencies prior to submitting to payers’ insurance eligibility verification
• Electronic Remittance Advice/Explanation of Benefits posting and denial management workflows
• Support for cosmetic and self-pay billing
• Ability to generate superbills (itemized receipts for medical services that include International Classification of Diseases Tenth Revision and Current Procedural Terminology codes; patients can submit these directly to their insurance company for reimbursement) for direct-pay practices

Why It Matters—Strong RCM functionality protects revenue, reduces denials, and minimizes staff workload.

Scheduling and Practice Integration

The most effective EMRs tightly integrate clinical charting with daily practice operations. Features to evaluate include the following:

• Integrated scheduling with color-coded calendars
• Appointment-type templates and block scheduling
• Automated patient reminders via text or email
• Support for multiprovider and multilocation practices
• Integration with outside pathology or lab services

Why It Matters—Clear and templated scheduling and practice integration help practices run more smoothly by reducing administrative workload and errors and coordinating communication between providers and even ancillary services.

Telehealth and Patient Communication Tools

Patient communication and virtual care are increasingly important in dermatology. When evaluating EMRs, compare the following:

• Built-in telehealth functionality vs third-party integrations
• Automated appointment reminders
• Patient portal features (forms, messaging, results)
• Online booking capabilities

Why It Matters—Integrated telehealth and patient communication tools improve access to care, enhance patient engagement, and streamline scheduling, messaging, and virtual visits within dermatology workflows.

Reporting and Analytics

Reporting capabilities support clinical quality, compliance, and business decision-making. Key reporting areas include the following:

• Clinical reports (outcomes, lesion tracking, disease management)
• Financial reports (revenue per provider, payer mix, visit types)
• Customizable or exportable reporting tools

Why It Matters—Robust reporting and analytics help dermatology practices track clinical outcomes, monitor financial performance, and make data-driven decisions to improve both patient care and practice management.

Support, Training, and User Community

The user experience after implementation of the EMR is just as important as the software itself. Evaluate the following after the EMR is implemented:

• Initial training and onboarding resources
• Availability of dermatology-specific support teams
• Ongoing education, help centers, or user communities
• Access to dedicated implementation or success managers

Why It Matters—Strong training and support resources help ensure a smoother EMR implementation, faster staff adoption, and ongoing optimization of the system for dermatology workflows.

Cost and Overall Value

Finally, look beyond the sticker price. The total cost of ownership includes far more than monthly fees. Compare the following:

• Upfront costs (implementation, data migration, training)
• Subscription pricing (per provider or per user)
• Billing or RCM fees (including percentages of collections if applicable) and payment processing fees
• Costs for add-on modules (telehealth, imaging, analytics)
• Contract length and termination terms

Why It Matters—Understanding the full cost of ownership helps dermatology practices choose an EMR that fits their budget long-term while avoiding unexpected fees and contractual limitations.

Final Thoughts

There is no single “best” EMR for every dermatology practice. The right choice depends on your practice model, payer mix, clinical focus, and growth plans. By evaluating EMRs through a dermatology-specific lens and asking the right questions, you can choose a system that supports both excellent patient care and long-term practice success.

Choosing an electronic medical record (EMR) is one of the most important clinical and financial decisions a dermatology practice will make. An effective system can help streamline workflows, support high-quality patient care, and protect revenue, while the wrong choice can slow clinicians down and add to the administrative burden.

Dermatology workflows involve unique documentation, imaging, and billing needs that are not always well served by generic EMR platforms. To help guide the selection of an EMR, the following framework outlines key features and practice considerations specific to dermatology practices.

Dermatology-Specific Charting

While many general EMRs offer customization, dermatology practices benefit greatly from ready-built, specialty-specific documentation tools. Key elements to evaluate include the following:

• Preconfigured dermatology templates for common conditions and procedures (eg, acne, psoriasis, melanoma, biopsies, cosmetic treatments)
• Smart-phrase libraries tailored to dermatologic language and examinations
• Ability to create, modify, and share custom templates across providers

Why It Matters—Efficient charting reduces documentation time, improves consistency, and supports accurate coding.

Clinical Photography and Imaging

Dermatology is a highly visual specialty, making clinical photography and image management essential. Important capabilities of an EMR include the following:

• Easy capture, annotation, and longitudinal tracking of clinical images
• Seamless embedding of photographs directly into the patient chart
• Side-by-side comparison of current and prior images
• Secure image storage and camera integration
• Body-mapping tools to mark and track lesion locations visually

Why It Matters—A high-quality image workflow supports diagnosis, treatment planning, patient education, and medicolegal documentation.

Coding, Billing, and Revenue Cycle Support

For insurance-based practices, robust billing and revenue cycle management (RCM) tools are critical. For direct-care models, some of these items may be prioritized lower. Key features to compare include the following:

• Support for International Classification of Diseases, 10th Revision, Clinical Modification; Current Procedural Terminology; and dermatology-specific code sets
• Automated coding suggestions tied to clinical documentation
• Reviewing claims for errors and inconsistencies prior to submitting to payers’ insurance eligibility verification
• Electronic Remittance Advice/Explanation of Benefits posting and denial management workflows
• Support for cosmetic and self-pay billing
• Ability to generate superbills (itemized receipts for medical services that include International Classification of Diseases Tenth Revision and Current Procedural Terminology codes; patients can submit these directly to their insurance company for reimbursement) for direct-pay practices

Why It Matters—Strong RCM functionality protects revenue, reduces denials, and minimizes staff workload.

Scheduling and Practice Integration

The most effective EMRs tightly integrate clinical charting with daily practice operations. Features to evaluate include the following:

• Integrated scheduling with color-coded calendars
• Appointment-type templates and block scheduling
• Automated patient reminders via text or email
• Support for multiprovider and multilocation practices
• Integration with outside pathology or lab services

Why It Matters—Clear and templated scheduling and practice integration help practices run more smoothly by reducing administrative workload and errors and coordinating communication between providers and even ancillary services.

Telehealth and Patient Communication Tools

Patient communication and virtual care are increasingly important in dermatology. When evaluating EMRs, compare the following:

• Built-in telehealth functionality vs third-party integrations
• Automated appointment reminders
• Patient portal features (forms, messaging, results)
• Online booking capabilities

Why It Matters—Integrated telehealth and patient communication tools improve access to care, enhance patient engagement, and streamline scheduling, messaging, and virtual visits within dermatology workflows.

Reporting and Analytics

Reporting capabilities support clinical quality, compliance, and business decision-making. Key reporting areas include the following:

• Clinical reports (outcomes, lesion tracking, disease management)
• Financial reports (revenue per provider, payer mix, visit types)
• Customizable or exportable reporting tools

Why It Matters—Robust reporting and analytics help dermatology practices track clinical outcomes, monitor financial performance, and make data-driven decisions to improve both patient care and practice management.

Support, Training, and User Community

The user experience after implementation of the EMR is just as important as the software itself. Evaluate the following after the EMR is implemented:

• Initial training and onboarding resources
• Availability of dermatology-specific support teams
• Ongoing education, help centers, or user communities
• Access to dedicated implementation or success managers

Why It Matters—Strong training and support resources help ensure a smoother EMR implementation, faster staff adoption, and ongoing optimization of the system for dermatology workflows.

Cost and Overall Value

Finally, look beyond the sticker price. The total cost of ownership includes far more than monthly fees. Compare the following:

• Upfront costs (implementation, data migration, training)
• Subscription pricing (per provider or per user)
• Billing or RCM fees (including percentages of collections if applicable) and payment processing fees
• Costs for add-on modules (telehealth, imaging, analytics)
• Contract length and termination terms

Why It Matters—Understanding the full cost of ownership helps dermatology practices choose an EMR that fits their budget long-term while avoiding unexpected fees and contractual limitations.

Final Thoughts

There is no single “best” EMR for every dermatology practice. The right choice depends on your practice model, payer mix, clinical focus, and growth plans. By evaluating EMRs through a dermatology-specific lens and asking the right questions, you can choose a system that supports both excellent patient care and long-term practice success.

Choosing an electronic medical record (EMR) is one of the most important clinical and financial decisions a dermatology practice will make. An effective system can help streamline workflows, support high-quality patient care, and protect revenue, while the wrong choice can slow clinicians down and add to the administrative burden.

Dermatology workflows involve unique documentation, imaging, and billing needs that are not always well served by generic EMR platforms. To help guide the selection of an EMR, the following framework outlines key features and practice considerations specific to dermatology practices.

Dermatology-Specific Charting

While many general EMRs offer customization, dermatology practices benefit greatly from ready-built, specialty-specific documentation tools. Key elements to evaluate include the following:

• Preconfigured dermatology templates for common conditions and procedures (eg, acne, psoriasis, melanoma, biopsies, cosmetic treatments)
• Smart-phrase libraries tailored to dermatologic language and examinations
• Ability to create, modify, and share custom templates across providers

Why It Matters—Efficient charting reduces documentation time, improves consistency, and supports accurate coding.

Clinical Photography and Imaging

Dermatology is a highly visual specialty, making clinical photography and image management essential. Important capabilities of an EMR include the following:

• Easy capture, annotation, and longitudinal tracking of clinical images
• Seamless embedding of photographs directly into the patient chart
• Side-by-side comparison of current and prior images
• Secure image storage and camera integration
• Body-mapping tools to mark and track lesion locations visually

Why It Matters—A high-quality image workflow supports diagnosis, treatment planning, patient education, and medicolegal documentation.

Coding, Billing, and Revenue Cycle Support

For insurance-based practices, robust billing and revenue cycle management (RCM) tools are critical. For direct-care models, some of these items may be prioritized lower. Key features to compare include the following:

• Support for International Classification of Diseases, 10th Revision, Clinical Modification; Current Procedural Terminology; and dermatology-specific code sets
• Automated coding suggestions tied to clinical documentation
• Reviewing claims for errors and inconsistencies prior to submitting to payers’ insurance eligibility verification
• Electronic Remittance Advice/Explanation of Benefits posting and denial management workflows
• Support for cosmetic and self-pay billing
• Ability to generate superbills (itemized receipts for medical services that include International Classification of Diseases Tenth Revision and Current Procedural Terminology codes; patients can submit these directly to their insurance company for reimbursement) for direct-pay practices

Why It Matters—Strong RCM functionality protects revenue, reduces denials, and minimizes staff workload.

Scheduling and Practice Integration

The most effective EMRs tightly integrate clinical charting with daily practice operations. Features to evaluate include the following:

• Integrated scheduling with color-coded calendars
• Appointment-type templates and block scheduling
• Automated patient reminders via text or email
• Support for multiprovider and multilocation practices
• Integration with outside pathology or lab services

Why It Matters—Clear and templated scheduling and practice integration help practices run more smoothly by reducing administrative workload and errors and coordinating communication between providers and even ancillary services.

Telehealth and Patient Communication Tools

Patient communication and virtual care are increasingly important in dermatology. When evaluating EMRs, compare the following:

• Built-in telehealth functionality vs third-party integrations
• Automated appointment reminders
• Patient portal features (forms, messaging, results)
• Online booking capabilities

Why It Matters—Integrated telehealth and patient communication tools improve access to care, enhance patient engagement, and streamline scheduling, messaging, and virtual visits within dermatology workflows.

Reporting and Analytics

Reporting capabilities support clinical quality, compliance, and business decision-making. Key reporting areas include the following:

• Clinical reports (outcomes, lesion tracking, disease management)
• Financial reports (revenue per provider, payer mix, visit types)
• Customizable or exportable reporting tools

Why It Matters—Robust reporting and analytics help dermatology practices track clinical outcomes, monitor financial performance, and make data-driven decisions to improve both patient care and practice management.

Support, Training, and User Community

The user experience after implementation of the EMR is just as important as the software itself. Evaluate the following after the EMR is implemented:

• Initial training and onboarding resources
• Availability of dermatology-specific support teams
• Ongoing education, help centers, or user communities
• Access to dedicated implementation or success managers

Why It Matters—Strong training and support resources help ensure a smoother EMR implementation, faster staff adoption, and ongoing optimization of the system for dermatology workflows.

Cost and Overall Value

Finally, look beyond the sticker price. The total cost of ownership includes far more than monthly fees. Compare the following:

• Upfront costs (implementation, data migration, training)
• Subscription pricing (per provider or per user)
• Billing or RCM fees (including percentages of collections if applicable) and payment processing fees
• Costs for add-on modules (telehealth, imaging, analytics)
• Contract length and termination terms

Why It Matters—Understanding the full cost of ownership helps dermatology practices choose an EMR that fits their budget long-term while avoiding unexpected fees and contractual limitations.

Final Thoughts

There is no single “best” EMR for every dermatology practice. The right choice depends on your practice model, payer mix, clinical focus, and growth plans. By evaluating EMRs through a dermatology-specific lens and asking the right questions, you can choose a system that supports both excellent patient care and long-term practice success.

In April 2024, the Federal Trade Commission (FTC) issued a nationwide rule to ban most employee noncompete agreements, including many used in health care¹; however, that rule never took effect. In August 2024, a federal district court ruled that the FTC had exceeded its statutory authority and blocked the ban,² and subsequent litigation and agency actions followed. On September 5, 2025, the FTC formally moved to accede to vacatur—in other words, it will not enforce the rule and backed away from defending it on appeal.³ As of December 2025, there is no active federal ban on physician noncompetes. The obligations of the physician employee are dictated by state law and the precise language of the contract that is signed.

In this article, we discuss the historical origins of noncompetes, employer and physician perspectives, and the downstream consequences for patient continuity, access, and health care costs.

Background

The concept of noncompete agreements is not new—this legal principle dates back several centuries, but it was not until several hundred years later, between the 1950s and 1980s, that noncompete agreements became routine in physician contracts. This trend emerged, at least in part, from the growing commoditization of medicine, the expansion of hospital infrastructure, and the rise of physicians employed by entities rather than owning a private practice. Medical practices, hospitals, and increasingly large private groups began using noncompete agreements to prevent physicians from leaving and establishing competing practices nearby. Since then, noncompetes have remained a contentious issue within both the legal system and the broader physician-employer relationship.

Employer vs Employee Perspective

From the employer’s perspective, health care systems and medical groups argue that noncompete agreements are necessary to protect legitimate business interests, citing physician training, established patient relationships, and proprietary information gained from employment with that entity as supporting reasons. Additionally, employers maintain that recouping the cost of recruitment and onboarding investments as well as sustaining continuity of care within the organization should take precedence. On occasion, health care systems will invest time and financial resources in recruiting physicians, provide administrative and clinical support, and integrate new employees into established referral pathways and patient populations. In this view, noncompetes serve as a tool to ensure stability within the health care system, discouraging abrupt departures that could fracture patient care or lead to unfair competition using institutional resources. While these arguments hold merit in certain cases, many physicians do not receive employer-funded education or training beyond what is required in residency and fellowship. As a result, the financial justifications for noncompetes often are overstated; on the contrary, the cost of a “buy-out” or the financial barrier imposed by a noncompete clause can amount to a considerable portion of a physician’s annual salary—sometimes multiple times that amount—creating an imbalance that favors the employer and limits professional mobility.

When a physician is prohibited from practicing in a specific area after leaving an employer, a complex web of adverse consequences can arise, impacting both the physician and the patients they serve. Physician mobility and career choice become restricted, effectively constraining the physicians’ livelihood and ability to provide for themselves and their dependents; in single-earner physician families, this can have devastating financial consequences. These limitations contribute to growing burnout and dissatisfaction within the medical profession, which already is facing unprecedented levels of stress and physician workforce shortages.⁴

Effect on Patients

When a physician is forced to relocate to a new geographic region because of a noncompete clause, their patients can experience substantial disruptions in care. Access to medical services may be affected, leading to longer wait-times and fewer available appointments, especially in areas that already have a shortage of providers. Patients may lose longstanding relationships with doctors who know their medical histories, which can interrupt treatment plans and increase the risk of complications. Those with chronic illnesses, complex conditions, or time-sensitive treatments are particularly vulnerable to adverse outcomes. Many patients must travel farther—sometimes out of their insurance network—to find replacement care, increasing both financial and logistical burdens. These abrupt transitions also can raise health care costs due to emergency department use, inefficient handoffs, and higher incidence of morbidity/mortality.⁵ Noncompete restrictions often prevent physicians from informing patients where they are relocating, creating confusion and fragmentation of care. As a result, trust in the health care system may decline when patients perceive that business agreements are being prioritized above their wellbeing. The impact may be even more severe in rural or underserved communities where alternative providers are scarce.

Final Thoughts

In recent years, noncompete agreements in health care have come under intensified scrutiny for their potential to stifle physician mobility, reduce competition, and inflate health care costs by limiting where and how physicians can practice. The trajectory of noncompetes in physician employment reflects broader shifts in how medicine is structured and delivered in the United States. In the latter half of the 20th century, what began as a centuries-old legal concept became a standard feature of physician employment contracts. That evolution largely was driven by the corporatization of medicine and large hospital group/private equity employment of physicians. As these agreements proliferated, public policy questions emerged: What does restricting a physician’s mobility do to patient access? To competition in provider markets? To the cost and availability of care? To the current epidemic of physician burnout?

These questions moved from the legal sidelines to center stage in the 2020s, when the FTC sought to tackle noncompetes across the entire economy—physicians included—on the theory they suppressed labor mobility, entrepreneurship, and competition. In February 2020, the American Medical Association submitted comments to the FTC on the utility of noncompete agreements in employee contracts stating that they restrict competition, can disrupt continuity of care, and may limit access to care.⁶ Although the FTC’s regulatory attempt in April 2024 provoked strong policy signals, it was challenged and ultimately blocked. Rather than a clear federal prohibition, the outcome is a more incremental state-based shift in rules governing physician noncompetes. For physicians today, this means more awareness and more leverage, but also more complexity. Whether a noncompete will be enforceable depends heavily on the state, the wording of the contract, the structure of the employer, and the specialty. From a negotiation standpoint, physicians need more guidance and awareness on the exact ramifications of their employee contract. For newly minted physicians, many of whom enter the workforce with considerable training debt, the priority often is securing employment to work toward financial stability, building a family, or both; however, all physicians should press for shorter durations, tighter geographic limits, narrower scopes of service, clear buy-out options, and explicit patient-continuity protections. Better yet, physicians can exercise the right of refusal to any noncompete clause at all. Becoming involved with a local medical organization or foundation can provide immense support, both in reviewing contracts as well as learning how to become advocates for physicians in this environment. As more physicians stand together to protect both practice autonomy and the right to quality care, we all become closer to rediscovering the beauty and fulfillment in the purest form of medicine.

In April 2024, the Federal Trade Commission (FTC) issued a nationwide rule to ban most employee noncompete agreements, including many used in health care¹; however, that rule never took effect. In August 2024, a federal district court ruled that the FTC had exceeded its statutory authority and blocked the ban,² and subsequent litigation and agency actions followed. On September 5, 2025, the FTC formally moved to accede to vacatur—in other words, it will not enforce the rule and backed away from defending it on appeal.³ As of December 2025, there is no active federal ban on physician noncompetes. The obligations of the physician employee are dictated by state law and the precise language of the contract that is signed.

In this article, we discuss the historical origins of noncompetes, employer and physician perspectives, and the downstream consequences for patient continuity, access, and health care costs.

Background

The concept of noncompete agreements is not new—this legal principle dates back several centuries, but it was not until several hundred years later, between the 1950s and 1980s, that noncompete agreements became routine in physician contracts. This trend emerged, at least in part, from the growing commoditization of medicine, the expansion of hospital infrastructure, and the rise of physicians employed by entities rather than owning a private practice. Medical practices, hospitals, and increasingly large private groups began using noncompete agreements to prevent physicians from leaving and establishing competing practices nearby. Since then, noncompetes have remained a contentious issue within both the legal system and the broader physician-employer relationship.

Employer vs Employee Perspective

From the employer’s perspective, health care systems and medical groups argue that noncompete agreements are necessary to protect legitimate business interests, citing physician training, established patient relationships, and proprietary information gained from employment with that entity as supporting reasons. Additionally, employers maintain that recouping the cost of recruitment and onboarding investments as well as sustaining continuity of care within the organization should take precedence. On occasion, health care systems will invest time and financial resources in recruiting physicians, provide administrative and clinical support, and integrate new employees into established referral pathways and patient populations. In this view, noncompetes serve as a tool to ensure stability within the health care system, discouraging abrupt departures that could fracture patient care or lead to unfair competition using institutional resources. While these arguments hold merit in certain cases, many physicians do not receive employer-funded education or training beyond what is required in residency and fellowship. As a result, the financial justifications for noncompetes often are overstated; on the contrary, the cost of a “buy-out” or the financial barrier imposed by a noncompete clause can amount to a considerable portion of a physician’s annual salary—sometimes multiple times that amount—creating an imbalance that favors the employer and limits professional mobility.

When a physician is prohibited from practicing in a specific area after leaving an employer, a complex web of adverse consequences can arise, impacting both the physician and the patients they serve. Physician mobility and career choice become restricted, effectively constraining the physicians’ livelihood and ability to provide for themselves and their dependents; in single-earner physician families, this can have devastating financial consequences. These limitations contribute to growing burnout and dissatisfaction within the medical profession, which already is facing unprecedented levels of stress and physician workforce shortages.⁴

Effect on Patients

When a physician is forced to relocate to a new geographic region because of a noncompete clause, their patients can experience substantial disruptions in care. Access to medical services may be affected, leading to longer wait-times and fewer available appointments, especially in areas that already have a shortage of providers. Patients may lose longstanding relationships with doctors who know their medical histories, which can interrupt treatment plans and increase the risk of complications. Those with chronic illnesses, complex conditions, or time-sensitive treatments are particularly vulnerable to adverse outcomes. Many patients must travel farther—sometimes out of their insurance network—to find replacement care, increasing both financial and logistical burdens. These abrupt transitions also can raise health care costs due to emergency department use, inefficient handoffs, and higher incidence of morbidity/mortality.⁵ Noncompete restrictions often prevent physicians from informing patients where they are relocating, creating confusion and fragmentation of care. As a result, trust in the health care system may decline when patients perceive that business agreements are being prioritized above their wellbeing. The impact may be even more severe in rural or underserved communities where alternative providers are scarce.

Final Thoughts

In recent years, noncompete agreements in health care have come under intensified scrutiny for their potential to stifle physician mobility, reduce competition, and inflate health care costs by limiting where and how physicians can practice. The trajectory of noncompetes in physician employment reflects broader shifts in how medicine is structured and delivered in the United States. In the latter half of the 20th century, what began as a centuries-old legal concept became a standard feature of physician employment contracts. That evolution largely was driven by the corporatization of medicine and large hospital group/private equity employment of physicians. As these agreements proliferated, public policy questions emerged: What does restricting a physician’s mobility do to patient access? To competition in provider markets? To the cost and availability of care? To the current epidemic of physician burnout?

These questions moved from the legal sidelines to center stage in the 2020s, when the FTC sought to tackle noncompetes across the entire economy—physicians included—on the theory they suppressed labor mobility, entrepreneurship, and competition. In February 2020, the American Medical Association submitted comments to the FTC on the utility of noncompete agreements in employee contracts stating that they restrict competition, can disrupt continuity of care, and may limit access to care.⁶ Although the FTC’s regulatory attempt in April 2024 provoked strong policy signals, it was challenged and ultimately blocked. Rather than a clear federal prohibition, the outcome is a more incremental state-based shift in rules governing physician noncompetes. For physicians today, this means more awareness and more leverage, but also more complexity. Whether a noncompete will be enforceable depends heavily on the state, the wording of the contract, the structure of the employer, and the specialty. From a negotiation standpoint, physicians need more guidance and awareness on the exact ramifications of their employee contract. For newly minted physicians, many of whom enter the workforce with considerable training debt, the priority often is securing employment to work toward financial stability, building a family, or both; however, all physicians should press for shorter durations, tighter geographic limits, narrower scopes of service, clear buy-out options, and explicit patient-continuity protections. Better yet, physicians can exercise the right of refusal to any noncompete clause at all. Becoming involved with a local medical organization or foundation can provide immense support, both in reviewing contracts as well as learning how to become advocates for physicians in this environment. As more physicians stand together to protect both practice autonomy and the right to quality care, we all become closer to rediscovering the beauty and fulfillment in the purest form of medicine.

In April 2024, the Federal Trade Commission (FTC) issued a nationwide rule to ban most employee noncompete agreements, including many used in health care¹; however, that rule never took effect. In August 2024, a federal district court ruled that the FTC had exceeded its statutory authority and blocked the ban,² and subsequent litigation and agency actions followed. On September 5, 2025, the FTC formally moved to accede to vacatur—in other words, it will not enforce the rule and backed away from defending it on appeal.³ As of December 2025, there is no active federal ban on physician noncompetes. The obligations of the physician employee are dictated by state law and the precise language of the contract that is signed.

In this article, we discuss the historical origins of noncompetes, employer and physician perspectives, and the downstream consequences for patient continuity, access, and health care costs.

Background

The concept of noncompete agreements is not new—this legal principle dates back several centuries, but it was not until several hundred years later, between the 1950s and 1980s, that noncompete agreements became routine in physician contracts. This trend emerged, at least in part, from the growing commoditization of medicine, the expansion of hospital infrastructure, and the rise of physicians employed by entities rather than owning a private practice. Medical practices, hospitals, and increasingly large private groups began using noncompete agreements to prevent physicians from leaving and establishing competing practices nearby. Since then, noncompetes have remained a contentious issue within both the legal system and the broader physician-employer relationship.

Employer vs Employee Perspective

From the employer’s perspective, health care systems and medical groups argue that noncompete agreements are necessary to protect legitimate business interests, citing physician training, established patient relationships, and proprietary information gained from employment with that entity as supporting reasons. Additionally, employers maintain that recouping the cost of recruitment and onboarding investments as well as sustaining continuity of care within the organization should take precedence. On occasion, health care systems will invest time and financial resources in recruiting physicians, provide administrative and clinical support, and integrate new employees into established referral pathways and patient populations. In this view, noncompetes serve as a tool to ensure stability within the health care system, discouraging abrupt departures that could fracture patient care or lead to unfair competition using institutional resources. While these arguments hold merit in certain cases, many physicians do not receive employer-funded education or training beyond what is required in residency and fellowship. As a result, the financial justifications for noncompetes often are overstated; on the contrary, the cost of a “buy-out” or the financial barrier imposed by a noncompete clause can amount to a considerable portion of a physician’s annual salary—sometimes multiple times that amount—creating an imbalance that favors the employer and limits professional mobility.

When a physician is prohibited from practicing in a specific area after leaving an employer, a complex web of adverse consequences can arise, impacting both the physician and the patients they serve. Physician mobility and career choice become restricted, effectively constraining the physicians’ livelihood and ability to provide for themselves and their dependents; in single-earner physician families, this can have devastating financial consequences. These limitations contribute to growing burnout and dissatisfaction within the medical profession, which already is facing unprecedented levels of stress and physician workforce shortages.⁴

Effect on Patients

When a physician is forced to relocate to a new geographic region because of a noncompete clause, their patients can experience substantial disruptions in care. Access to medical services may be affected, leading to longer wait-times and fewer available appointments, especially in areas that already have a shortage of providers. Patients may lose longstanding relationships with doctors who know their medical histories, which can interrupt treatment plans and increase the risk of complications. Those with chronic illnesses, complex conditions, or time-sensitive treatments are particularly vulnerable to adverse outcomes. Many patients must travel farther—sometimes out of their insurance network—to find replacement care, increasing both financial and logistical burdens. These abrupt transitions also can raise health care costs due to emergency department use, inefficient handoffs, and higher incidence of morbidity/mortality.⁵ Noncompete restrictions often prevent physicians from informing patients where they are relocating, creating confusion and fragmentation of care. As a result, trust in the health care system may decline when patients perceive that business agreements are being prioritized above their wellbeing. The impact may be even more severe in rural or underserved communities where alternative providers are scarce.

Final Thoughts

In recent years, noncompete agreements in health care have come under intensified scrutiny for their potential to stifle physician mobility, reduce competition, and inflate health care costs by limiting where and how physicians can practice. The trajectory of noncompetes in physician employment reflects broader shifts in how medicine is structured and delivered in the United States. In the latter half of the 20th century, what began as a centuries-old legal concept became a standard feature of physician employment contracts. That evolution largely was driven by the corporatization of medicine and large hospital group/private equity employment of physicians. As these agreements proliferated, public policy questions emerged: What does restricting a physician’s mobility do to patient access? To competition in provider markets? To the cost and availability of care? To the current epidemic of physician burnout?

These questions moved from the legal sidelines to center stage in the 2020s, when the FTC sought to tackle noncompetes across the entire economy—physicians included—on the theory they suppressed labor mobility, entrepreneurship, and competition. In February 2020, the American Medical Association submitted comments to the FTC on the utility of noncompete agreements in employee contracts stating that they restrict competition, can disrupt continuity of care, and may limit access to care.⁶ Although the FTC’s regulatory attempt in April 2024 provoked strong policy signals, it was challenged and ultimately blocked. Rather than a clear federal prohibition, the outcome is a more incremental state-based shift in rules governing physician noncompetes. For physicians today, this means more awareness and more leverage, but also more complexity. Whether a noncompete will be enforceable depends heavily on the state, the wording of the contract, the structure of the employer, and the specialty. From a negotiation standpoint, physicians need more guidance and awareness on the exact ramifications of their employee contract. For newly minted physicians, many of whom enter the workforce with considerable training debt, the priority often is securing employment to work toward financial stability, building a family, or both; however, all physicians should press for shorter durations, tighter geographic limits, narrower scopes of service, clear buy-out options, and explicit patient-continuity protections. Better yet, physicians can exercise the right of refusal to any noncompete clause at all. Becoming involved with a local medical organization or foundation can provide immense support, both in reviewing contracts as well as learning how to become advocates for physicians in this environment. As more physicians stand together to protect both practice autonomy and the right to quality care, we all become closer to rediscovering the beauty and fulfillment in the purest form of medicine.